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OCR HIPAA Privacy

December 3, 2002
Revised April 3, 2003

DISCLOSURES FOR PUBLIC HEALTH ACTIVITIES


[45 CFR 164.512(b)]

Background

The HIPAA Privacy Rule recognizes the legitimate need for public health authorities and
others responsible for ensuring public health and safety to have access to protected health
information to carry out their public health mission. The Rule also recognizes that public health
reports made by covered entities are an important means of identifying threats to the health and
safety of the public at large, as well as individuals. Accordingly, the Rule permits covered
entities to disclose protected health information without authorization for specified public health
purposes.

How the Rule Works

General Public Health Activities. The Privacy Rule permits covered entities to disclose
protected health information, without authorization, to public health authorities who are legally
authorized to receive such reports for the purpose of preventing or controlling disease, injury, or
disability. This would include, for example, the reporting of a disease or injury; reporting vital
events, such as births or deaths; and conducting public health surveillance, investigations, or
interventions. See 45 CFR 164.512(b)(1)(i). Also, covered entities may, at the direction of a
public health authority, disclose protected health information to a foreign government agency
that is acting in collaboration with a public health authority. See 45 CFR 164.512(b)(1)(i).
Covered entities who are also a public health authority may use, as well as disclose, protected
health information for these public health purposes. See 45 CFR 164.512(b)(2).

A “public health authority” is an agency or authority of the United States government, a


State, a territory, a political subdivision of a State or territory, or Indian tribe that is responsible
for public health matters as part of its official mandate, as well as a person or entity acting under
a grant of authority from, or under a contract with, a public health agency. See 45 CFR 164.501.
Examples of a public health authority include State and local health departments, the Food and
Drug Administration (FDA), the Centers for Disease Control and Prevention, and the
Occupational Safety and Health Administration (OSHA).

Generally, covered entities are required reasonably to limit the protected health
information disclosed for public health purposes to the minimum amount necessary to
accomplish the public health purpose. However, covered entities are not required to make a
minimum necessary determination for public health disclosures that are made pursuant to an
individual’s authorization, or for disclosures that are required by other law. See 45 CFR
164.502(b). For disclosures to a public health authority, covered entities may reasonably rely on
a minimum necessary determination made by the public health authority in requesting the
protected health information. See 45 CFR 164.514(d)(3)(iii)(A). For routine and recurring
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December 3, 2002
Revised April 3, 2003

public health disclosures, covered entities may develop standard protocols, as part of their
minimum necessary policies and procedures, that address the types and amount of protected
health information that may be disclosed for such purposes. See 45 CFR 164.514(d)(3)(i).

Other Public Health Activities. The Privacy Rule recognizes the important role that
persons or entities other than public health authorities play in certain essential public health
activities. Accordingly, the Rule permits covered entities to disclose protected health
information, without authorization, to such persons or entities for the public health activities
discussed below.

Child abuse or neglect. Covered entities may disclose protected health


information to report known or suspected child abuse or neglect, if the report is
made to a public health authority or other appropriate government authority that is
authorized by law to receive such reports. For instance, the social services
department of a local government might have legal authority to receive reports of
child abuse or neglect, in which case, the Privacy Rule would permit a covered
entity to report such cases to that authority without obtaining individual
authorization. Likewise, a covered entity could report such cases to the police
department when the police department is authorized by law to receive such
reports. See 45 CFR 164.512(b)(1)(ii). See also 45 CFR 512(c) for information
regarding disclosures about adult victims of abuse, neglect, or domestic violence.

Quality, safety or effectiveness of a product or activity regulated by the FDA. Covered


entities may disclose protected health information to a person subject to FDA
jurisdiction, for public health purposes related to the quality, safety or
effectiveness of an FDA-regulated product or activity for which that person has
responsibility. Examples of purposes or activities for which such disclosures may
be made include, but are not limited to:

Collecting or reporting adverse events (including similar reports regarding food


and dietary supplements), product defects or problems (including
problems regarding use or labeling), or biological product deviations;
Tracking FDA-regulated products;
Enabling product recalls, repairs, replacement or lookback (which includes
locating and notifying individuals who received recalled or withdrawn
products or products that are the subject of lookback); and
Conducting post-marketing surveillance.

See 45 CFR 164.512(b)(1)(iii). The “person” subject to the jurisdiction of the


FDA does not have to be a specific individual. Rather, it can be an individual or
an entity, such as a partnership, corporation, or association. Covered entities may
identify the party or parties responsible for an FDA-regulated product from the
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product label, from written material that accompanies the product (know as
labeling), or from sources of labeling, such as the Physician’s Desk Reference.

Persons at risk of contracting or spreading a disease. A covered entity may


disclose protected health information to a person who is at risk of contracting or
spreading a disease or condition if other law authorizes the covered entity to
notify such individuals as necessary to carry out public health interventions or
investigations. For example, a covered health care provider may disclose
protected health information as needed to notify a person that (s)he has been
exposed to a communicable disease if the covered entity is legally authorized to
do so to prevent or control the spread of the disease. See 45 CFR
164.512(b)(1)(iv).

Workplace medical surveillance. A covered health care provider who provides a health
care service to an individual at the request of the individual’s employer, or provides
the service in the capacity of a member of the employer’s workforce, may disclose the
individual’s protected health information to the employer for the purposes of
workplace medical surveillance or the evaluation of work-related illness and injuries
to the extent the employer needs that information to comply with OSHA, the Mine
Safety and Health Administration (MSHA), or the requirements of State laws having
a similar purpose. The information disclosed must be limited to the provider’s
findings regarding such medical surveillance or work-related illness or injury. The
covered health care provider must provide the individual with written notice that the
information will be disclosed to his or her employer (or the notice may be posted at
the worksite if that is where the service is provided). See 45 CFR 164.512(b)(1)(v).

Frequently Asked Questions

To see Privacy Rule FAQs, click the desired link below:

FAQs on Public Health Uses and Disclosures

FAQs on ALL Privacy Rule Topics

(You can also go to http://answers.hhs.gov/cgi-bin/hhs.cfg/php/enduser/std_alp.php, then


select "Privacy of Health Information/HIPAA" from the Category drop down list and
click the Search button.)